If you are injured or ill, an accurate medical diagnosis and effective treatment plan is critical for your health. When applying for Social Security disability benefits, having the correct medical provider is absolutely vital for your claim.
Social Security has rules about which medical providers they will accept diagnoses from. These providers are called Acceptable Medical Sources (AMS).
This is important because Social Security will generally not even consider a medical condition on your disability claim unless it was diagnosed by an AMS. And, many people receive treatment from providers who are not considered Acceptable Medical Sources under Social Security rules.
Why This Can Be a Problem
As an example, imagine you have severe back pain. You go to a chiropractor who diagnoses you with degenerative disc disease. The chiropractor adjusts your back, uses ultrasound therapy, and provides other treatment to help reduce your pain. The chiropractor then refers you to a physical therapist for additional treatment.
The physical therapist works with you on stretching, strengthening exercises, mobility, and pain management. Both providers document your pain and physical limitations. You attend treatment regularly and follow their medical advice. Although your back pain improves under this treatment, you are still not able to return to work and decide to file for disability benefits.
Unfortunately, your disability claim would probably be denied in this situation.
Social Security will not typically accept either the chiropractor or the physical therapist’s diagnosis, because neither of them are considered Acceptable Medical Sources. According to Social Security regulations, chiropractors and physical therapists aren’t authorized to diagnose medical conditions for purposes of Social Security disability.
What Would Happen Then?
In this case, Social Security may decide that your degenerative disc disease was never properly established unless an AMS such as a physician, nurse practitioner, or physician assistant has diagnosed the condition.
Does That Mean Those Records Do Not Matter?
No–records from chiropractors, physical therapists, counselors, therapists, and other providers can still help your case. These records may show:
- Pain levels
- Physical limitations
- Reduced movement
- Difficulty walking or standing
- Ongoing treatment
However, you will still need a diagnosis from an AMS before your disability claim will be considered, and it is best for you to build your medical history if possible.
Won’t Social Security Provide a Doctor?
If your existing records are insufficient, the SSA may pay for a one-time Consultative Examination (CE) with an independent doctor to evaluate your condition. These exams are usually brief, and Social Security will not pay for advanced diagnostic testing such as an MRI. In most cases, it is much better to obtain a diagnosis and treatment from your own Acceptable Medical Source whenever possible.
What Is an Acceptable Medical Source?
An Acceptable Medical Source is a medical provider who is licensed by the state and working within the bounds of their legal scope of practice, including:
- Physicians: Licensed Medical Doctor (MD) and Doctor of Osteopathic Medicine (DO).
- Advanced Practice Registered Nurses (APRNs): Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs).
- Physician Assistants (PAs)
- Psychologists
- Audiologists, Podiatrists, Optometrists, and Speech Language Pathologists may serve as an AMS if they are consulting directly about the impairment that you cite on your disability claim. For example, if you have a vision impairment, an optometrist may be referenced as an AMS, but a speech pathologist may not.
The Bottom Line
Not every medical provider qualifies as an Acceptable Medical Source. If you are applying for Social Security disability benefits, make sure your medical conditions have been diagnosed by the right type of medical provider.
Many people are surprised to learn that years of treatment may not be enough if the diagnosis did not come from an Acceptable Medical Source. Understanding this rule early can help you avoid delays and strengthen your disability claim.
At Disability Advocates, everything we do is focused on one goal: helping our clients obtain approval as efficiently and quickly as possible while protecting their claims every step of the way.